title: Solidago, orthosiphon, birch and cranberry extracts can decrease microbial colonization and biofilm development in indwelling urinary catheter: a microbiologic and ultrastructural pilot study.
abstract: OBJECTIVE
  Plants extracts are used in urology to manage urinary tract infections. We aimed to evaluate the efficacy of a preparation with solidago, orthosiphon, birch and cranberry extracts (CISTIMEV PLUS(®)) in reducing microbial colonization and biofilm development in patients with indwelling urinary catheters.
  
  
  METHODS
  All consecutive outpatients attending our department between January and June 2010 for the substitution of indwelling catheters were considered for this single-blinded, randomized and controlled pilot study to test superiority of the preventative management (CISTIMEV PLUS(®), 1 tablet daily for 30 days) in respect to no treatment. A sample size of 10-40 participants per group was considered adequate. All patients underwent urine culture the same day of the catheter substitution and were then randomized into test group (n = 48) and control group (n = 35). Ultrastructural analysis was also performed. After 30 days, the catheter was replaced and the analysis repeated. The primary outcome was the rate of positive urinary culture at the end of the entire study period.
  
  
  RESULTS
  Ten patients abandoned the study. At 30 days, according to per-protocol analysis, the groups statistically differed regarding the rate of positive urine cultures: test group 10/43 and control group 16/30 (p = 0.013) (-30.1 % [95 % CI -51.94 to -8.21]). The most common isolated bacteria were Escherichia coli and Enterococcus faecalis.
  
  
  CONCLUSIONS
  The use of solidago, orthosiphon, birch and cranberry extracts resulted in a significant reduction of microbial colonization in patients with indwelling urinary catheters. Larger clinical trials are needed to demonstrate that the effects here reported are sufficient to reduce symptomatic catheter-associated urinary tract infections.
authors.affiliation: Department of Urology, Santa Chiara Regional Hospital, Largo Medaglie d'Oro, 9, Trento, Italy, ktommy@libero.it.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Cai
authors.forename: Iole
authors.initials: I
authors.lastname: Caola
authors.forename: Francesco
authors.initials: F
authors.lastname: Tessarolo
authors.forename: Federico
authors.initials: F
authors.lastname: Piccoli
authors.forename: Carolina
authors.initials: C
authors.lastname: D'Elia
authors.forename: Patrizio
authors.initials: P
authors.lastname: Caciagli
authors.forename: Giandomenico
authors.initials: G
authors.lastname: Nollo
authors.forename: Gianni
authors.initials: G
authors.lastname: Malossini
authors.forename: Gabriella
authors.initials: G
authors.lastname: Nesi
authors.forename: Sandra
authors.initials: S
authors.lastname: Mazzoli
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bartoletti
mesh_terms: D000368:Aged; D001424:Bacterial Infections / Q000382:microbiology / Q000517:prevention & control; D029662:Betula; D018441:Biofilms / Q000187:drug effects*; D002408:Catheters, Indwelling / Q000382:microbiology; D015169:Colony Count, Microbial; D013293:Enterococcus faecalis / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D004926:Escherichia coli / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D031342:Orthosiphon; D010865:Pilot Projects; D010936:Plant Extracts / Q000494:pharmacology* / Q000627:therapeutic use; D016037:Single-Blind Method; D036624:Solidago; D062885:Urinary Catheters / Q000382:microbiology*; D014552:Urinary Tract Infections / Q000382:microbiology / Q000517:prevention & control; D029799:Vaccinium macrocarpon
chemical_list: D010936:Plant Extracts